• Total cancer
• Ischaemic heart disease
• Cerebrovascular disease
• Chronic lower respiratory diseases
• Other forms of heart disease
• Pneumonia and influenza
• Diabetes
• Motor vehicle accidents
• Intentional self-harm
• Assault
• Total deaths

To view the tables in an Excel spreadsheet, go to: http://www.health.govt.nz/publication/mortality-historical-summary-1948-2012

To find out more about this event as information becomes available, go to:  http://www.esmo.org/Conferences/ESMO-2016-Congress

Mixtures of common chemicals used in our environment may act in concert with each other in the human body to cause the development of cancer. This is the overall finding of ground-breaking new research by an international task force that included New Zealand.

Dr Linda Gulliver, from the University of Otago’s Faculty of Medicine, was the only New Zealand scientist selected to join an ‘Environmental Mixtures’ task force, one of two task forces assembled by an NGO called “Getting to Know Cancer” in Halifax Nova Scotia in July 2013.

Amid worldwide concern on high rates of cancer, the task force brought together 174 scientists from prominent institutions in 28 countries to tackle longstanding concerns that there are linkages between mixtures of commonly encountered chemicals and the development of cancer.

From the thousands of chemicals to which the population is now routinely exposed, the scientists selected 85 prototypic chemicals that were not considered to be carcinogenic to humans, and they reviewed their effects against a long list of mechanisms that are important for cancer development.

Working in teams that focused on various hallmarks (shared characteristics) of cancer, the group found that 50 of those chemicals examined supported key cancer-related mechanisms at environmentally relevant levels of exposure (i.e. levels at which humans are routinely exposed).

This supports the idea that chemicals may be capable of acting in concert with one another to cause cancer, even though low-level exposures to these chemicals individually might not be carcinogenic. 

“Since so many chemicals that are unavoidable in the environment can produce low-dose effects that are directly related to carcinogenesis, the way we've been testing chemicals (one at a time) is really quite out of date. Every day we are exposed to an environmental 'chemical soup', so we need testing that evaluates the effects of our ongoing exposure to these chemical mixtures,” says William Goodson III, a senior scientist at the California Pacific Medical Center in San Francisco.

Goodson is the lead author of this synthesis of the findings, which is today published (along with a seminal series of supporting reviews authored by each of the teams) in a special issue of the top-tier journal Carcinogenesis.

Their published report says: “Cumulative risk assessment methods that are based on ‘common mechanisms of toxicity’ or common ‘modes of action’ may be underestimating cancer-related risks….

“And current regulations in many countries (that consider only the cumulative effects of exposures to individual carcinogens that act via a common sequence of key events and processes on a common target/tissue to produce cancer) should be revisited.”

In light of this evidence, the task force is calling for an increased emphasis and support for research on low-dose exposures to mixtures of environmental chemicals.

This was the first time this large-scale problem has ever been considered by interdisciplinary teams that could fully interpret the full spectrum of cancer biology and incorporate what is now known about low-dose chemical effects.

Dr Linda Gulliver is a senior lecturer and reproductive biologist with an interest in oestrogen-related cancer causation. She was recruited into the “The Halifax Project” initiative in late December 2012.

Dr Gulliver was a member of the ‘Sustained Proliferative Signalling’ team, which looked at one of the ten established hallmarks of cancer cells; their ability to grow and multiply in an uncontrolled manner that is prevented in normally functioning cells.

She says her own team found that chemicals that act as environmental oestrogens and androgens play important roles in the activation of the cancer hallmark of “Sustained Proliferative Signalling,” as well as the cross-activation of several of the other cancer hallmarks.

And Dr Gulliver agrees with her colleague Dr David Carpenter, project contributor and Director of the Institute for Health and the Environment of the University at Albany in New York, that research into the area of how low-dose mixtures of environmental chemicals may facilitate cancer causation “merits considerable attention where interdisciplinary and international collaboration is needed.”

Dr. Carpenter adds: “The science in this field is changing rapidly. Although we know a lot about the individual effects of chemicals, we know very little about the combined and additive effects of the many chemicals that we encounter every day in the air, in our water and in our food.”

Current estimates suggest that as many as one in five cancers may be due to chemical exposures in the environment that are not related to personal lifestyle choices. So the effects of exposures to mixtures of commonly encountered chemicals needs to be better understood to try and reduce the incidence of cancer.

In a change to its 2005 predecessor, the updated guideline uses a new approach – focusing on the symptoms that a patient might experience and go to their doctor with - to make its recommendations easier for GPs to use. It sets out clear tables linking signs and symptoms to possible cancers and includes simple recommendations about which tests to perform and the type of referral to specialist services that should be made".

To read the full story on the NICE website, go to:  http://www.nice.org.uk/news/article/nice%E2%80%99s-new-symptom%E2%80%93based-approach-will-help-to-save-thousands-of-lives-from-cancer

Jonathan Coleman media release, 22 June 2015

Health Minister Jonathan Coleman has announced that Cancer Core, a group of students from the University of Otago, is the overall winner of the 2015 Minister of Health Volunteer Awards. 

“The health volunteer awards celebrate and recognise the thousands of dedicated health sector volunteers who give many hours of their time to help other New Zealanders,” says Dr Coleman.

“The judges were particularly impressed by the quality of this year’s entries. Well done to all those who were nominated and congratulations to those recognised as outstanding achievers.

“I would like to congratulate the overall winners Cancer Core. Their inaugural Relay for Life attracted more than 1,000 students and raised over $60,000 for the Cancer Society.”

Marking National Volunteer Week, Dr Coleman presented the Minister of Health Volunteer Awards in Parliament today.

Outstanding achievers were recognised across five categories – healthcare service provider, community or NGO, youth health, Māori and Pacific health, and long service.

A full list of recipients and categories can be found at: www.volunteerawards.health.govt.nz.

To find out more about this event, go to:  http://www.esmo.org/Conferences/EMUC-2015-Urological-Cancers

To find out more about this event, go to:  http://www.esmo.org/Conferences/Immuno-Oncology-2015

A UK pharmaceutical company is using Auckland University of Technology (AUT) bioengineering research for a potential break-through therapy for cancer.  

Agalimmune, which develops anti-cancer therapies for the treatment of solid tumours, has licensed engineered-molecule technology developed by AUT’s Centre for KODE Technology Innovation. It will use the KODE molecules (the synthetic glycolipid variations), which can attract the immune system to destroy cancer cells, in its new cancer immunotherapy product. AUT Professor of Biotech Innovation Stephen Henry, within the Centre for KODE Technology Innovation in the School of Engineering, described the technology to the New Zealand Herald as a “biological paint” that could add virtually any biological or non-biological material to almost any living or synthetic surface in just a few minutes. This includes cells, viruses, bugs and tumour cellss and solid surfaces such as glass, plastic, metals etc. 

Agalimmune has exclusive rights to use KODE’s molecules in the field of injection of tumours for cancer treatment. The KODE molecules will be used to label or modify the outside of cancerous tumours making them a target of the body’s immune system. In the process of destroying the tumour, the immune system will be educated to recognise and destroy other unmodified primary and secondary tumours. (see www.youtube.com/watch?v=pIiWgQRa66o for a video explanation). Working together, the two technologies have been shown to be effective for treatment of both primary and secondary tumours in animal models. 

Under the licence, KODE Biotech (an AUT spin out which has commercialised the technology) will receive up to $44 million in development and sales milestone payments, plus potentially 10’s of millions in annual royalties. 

Agalimmune director Graham Griffiths says, “We believe that this technology has great value in immunotherapy, and we are very pleased to be collaborating with a world-leader in the development of synthetic glycolipids. This licensing agreement also represents a significant step forward in Agalimmune’s progress towards the development of pioneering targeted cancer vaccines and immunotherapies for the benefit of patients.”

Professor Henry says, “We are delighted that Agalimmune has identified the potential of KODE™ Technology for this application, and we look forward to seeing the results of the next phase of development of the therapeutic.” 

 Also see http://www.nzherald.co.nz/science/news/article.cfm?c_id=82&objectid=11466262 for an interview by Jamie Morton from the New Zealand Herald.  

The European Lung Cancer Conference is a collaborative effort of multidisciplinary societies representing thoracic oncology specialists, all working towards a shared goal: to advance science, disseminate education and improve the practice of lung cancer specialists worldwide. 

To find out more about this event, go to:  http://www.esmo.org/Conferences/ELCC-2016-Lung-Cancer

To find out more about this event, go to:  http://www.esmo.org/Conferences/IMPAKT-2016-Breast-Cancer

To find out more about this event, go to:  http://www.cosa2015.org/

Its aim is to serve as an educational resource for practitioners from a wide array of disciplines engaged in the delivery of care to those with life threatening illnesses along the entire continuum of care from diagnosis to the end of life. The journal's scope is broad and relates to all aspects of palliative medicine that do not directly or exclusively deal with the administration of palliative care or hospice services, or with the primary management of pain and physical symptoms in palliative care.

Health Minister Jonathan Coleman says Waikato DHB is focused on delivering faster access to improve cancer services.

Dr Coleman visited Waikato Hospital’s chemotherapy day stay unit and met with staff and patients as well as representatives from the Cancer Society and Hospice Waikato.

The unit has up to seven registered nurses who treat 30 to 40 outpatients every day from Waikato, Tairawhiti and Lakes DHBs.

“Waikato DHB has a plan in place to provide faster access to cancer services to patients,” says Dr Coleman.

“As a regional cancer centre, Waikato DHB plays a significant role in the Midland region helping to treat patients as well as improving the delivery of cancer services.

“They are working towards achieving the Government’s new 62-day faster cancer treatment health target which puts the lens right across the cancer pathway.

“The DHB is also reviewing their systems against the national tumour standards for 11 of the most common tumour types which will help to improve the quality of care.”

Dr Coleman met with one of the DHB’s cancer nurse coordinators. They fill an important role, acting as a single point of contact for patients and families.

Cancer nurse coordinators also work closely with Hospice Waikato and Waikato-Bay of Plenty Cancer Society.

Budget 2015 invested an extra $4.6 million into Hospice Waikato over the next four years to expand community palliative care services.

Nineteen papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). "The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions".

The authors discuss the implications of these findings.

This article is available to read in free full text at:  http://www.ijic.org/index.php/ijic/article/view/1987/2983

Ngune, I., et al. (2015). Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. International Journal of Integrated Care, 8 June.

To download the toolkit, go to:  http://www.health.govt.nz/publication/lung-cancer-multidisciplinary-meeting-toolkit

National Lung Cancer Working Group (2014). Lung Cancer Multidisciplinary Meeting Toolkit. 

The global scientific research on diet, weight, physical activity and the risk of gallbladder cancer was systematically gathered and analysed, and then the results were independently assessed by a panel of leading international scientists in order to draw conclusions about whether these factors increase or decrease the risk of developing the disease.

The authors conclude that there is strong evidence that being overweight or obese increases the risk of gallbladder cancer.

The report and associated reports are available to download in full text at:  http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/gallbladder-cancer

World Cancer Research Fund International (2015). Diet, nutrition, physical activity and liver cancer. London: World Cancer Research Fund International.

University of Otago researchers have been awarded more than $30M in new health research funding to support their world-class studies aimed at improving New Zealanders’ health and well-being.

The Health Research Council of New Zealand’s latest annual funding round results were announced today. Otago researchers gained 18 contracts, including three major multi-million, five-year programmes and 15 projects.

Otago’s recipients span the University’s campuses in Dunedin, Christchurch and Wellington and each campus hosts one of the major new programmes.

Programmes focus on cancer genetics, key immune cells, and healthy housing

The new Dunedin campus-based programme, led by Pathology’s Professor Antony Braithwaite, will investigate the complex role that the p53 tumour suppressor genepathway plays in many cancers. Defects in this pathway are commonplace in cancers, making them an attractive target for improved therapies. The researchers will also examine links between cancer and inflammation. 

Professor Anthony Kettle of the University’s Christchurch campus will lead a programme studying the oxidative action of a common type of white blood cell known as neutrophils. These cells are a key line of defence against harmful bacteria, but when unrestrained during inflammation they damage healthy tissue. This aberrant activity occurs in many diseases, including pneumonia, arthritis, and heart disease. The long-term goal is to advance the diagnosis and treatment of inflammatory diseases dominated by neutrophils.

At the University’s Wellington campus Professor Philippa Howden-Chapman, head of the award-winning He Kainga Oranga: Housing and Health Research Programme, will lead an HRC programme that will translate their housing research to practice for children’s health. The researchers will examine health issues arising from children’s exposure to poor housing and trial several interventions, including one to insulate and warm newborn babies’ homes and provide them with feather duvets, and another to study air quality and possible health effects on children living in housing located beside arterial roads.

The three programmes are funded at nearly $5M each over five years.

15 new Otago projects to tackle a wide range of pressing health issues

Otago’s 15 new HRC projects range from studying a newly discovered neuronal pathway implicated in polycystic ovarian syndrome to testing how effectively modifications to front door steps can reduce falls and injuries around the home.

Several projects focus on child and young people’s health and include studies on the genetic causes of epilepsy, improving asthma outcomes in Maori children, and whether airway inflammation and infection can be reduced in cystic fibrosis by inhibiting white blood cells’ bleaching activity.

Three studies focus on the health of older New Zealanders. One will calculate osteoarthritis’s growing burden on the country’s ageing population and compare the promise and feasibility of potential strategies in cost-effectively managing this issue. 

Another study will trace people’s oral health from childhood into mid-life and examine its links with cardiovascular, and other, aspects of health. A third aims to help develop evidence-based policy and programmes to balance mobility and safety issues amongst older drivers. 

New cancer genetics-related projects include studies into breast cancer, acute myeloid leukaemia, and stomach cancer. The first project involves investigating the signalling pathways relating to Trib1, a protein that is often over-expressed in breast cancer. 

The second project will use zebrafish to study a newly discovered genetic pathway that may cause acute myeloid leukaemia and screen for drugs that selectively target this pathway.

Another study involves growing stomach tissue buds to test several drugs identified as preferentially killing cells that carry a specific mutation causing deadly diffuse stomach cancer. 

Other Otago projects focus on areas such as tobacco control in New Zealand, discrimination in healthcare, testing a seaweed extract nasal spray to treat adult asthma attacks caused by viral infections, and investigating potential therapies for preventing and treating heart disease in patients with diabetes.

Latest HRC funding successes reflect excellence of Otago researchers

Deputy Vice-Chancellor (Research and Enterprise) Professor Richard Blaikie warmly congratulated all the HRC programme and project recipients on their “dazzling success” in the funding round. 

“It is very pleasing to see that the excellent and innovative research proposals developed by our staff can now be pursued to continue to contribute to improved health and well-being of New Zealanders. Health Research Council funding has for the past 25 years underpinned important advances in health diagnostics, treatment, prevention and policies and this year will be no exception,” Professor Blaikie says.

The latest funding follows the announcement of the HRC Emerging Researcher First Grants and Feasibility Study recipients last month. Eight of the nine Emerging Researcher grants went to Otago staff, as did five of the nine Feasibility grants.

This brings Otago’s funding in the 2014 annual HRC round to a total of $31.98M.

The paper is available to read in free full text at:  http://dx.doi.org/10.5888/pcd12.150012

Momin B, Neri A, Goode SA, Sarris Esquivel N, Schmitt CL, Kahende J, et al. (2015). Factors involved in the collaboration between the national comprehensive cancer control programs and tobacco control programs: A qualitative study of 6 states, United States, 2012. Preventing Chronic Disease, 12:150012. 

The goal of the NDLR conferences is to bring together scientists and clinicians to discuss emerging paradigms and breakthroughs at the forefront of leukaemia research and treatment, from the molecular basis of leukaemia to new therapies emerging in the clinic.

To find out more, go to:  http://ndlr2016.com/

Primary health workers throughout the Whanganui District Health Board (WDHB) area have reason to celebrate as the Minister of Health’s national health targets results show primary care achieving the Better help for smokers to quit target for the first time with a 91 percent result. 
 
The results released today report the performance of DHBs against the six national health targets over the 2014/15 Quarter Three period of January to March 2015. Whanganui GP and national primary care tobacco target champion John McMenamin says he’s delighted to see the primary care Better help for smokers to quittarget reached in Whanganui.
 
“Whanganui health workers have every reason to celebrate. This result reflects the determination of primary health workers to encourage people to quit smoking,” Dr McMenamin says. “It’s a result that is very deserving as well as timely, with World Smokefree Day coming up on 31 May.”
 
While the WDHB narrowly missed out by one percent on achieving the 95 percent smoking target set for hospitals, the consistent results achieved for this target each quarter are a credit to the hospital staff offering advice and support for patients to quit smoking, says WDHB chief executive Julie Patterson.

Emergency Department clinical director Athol Steward is delighted that the WDHB’s hospital-wide efforts to admit, discharge or transfer 95 percent of patients from ED within the six-hour target, have been sustained. Dr Steward says it’s interesting to see the WDHB once again achieving 96 percent. “It shows consistency by the Whanganui Hospital’s entire clinical team and management.”
 
The 2014/15 Quarter Three national health target results show Whanganui district residents continue to enjoy a high access rate to elective surgical procedures with the DHB achieving 103 percent for the 100 percentImproved access to elective surgery.
 
But disappointingly, Whanganui’s result for the 95 percent Increased immunisation target has dropped to 86 percent. Whanganui Regional Health Network chief executive Judith McDonald says in addition to the 181 children who were immunised in this quarter, there were a further 19 children who did not receive their immunisation on time. “And given that the target performance includes families who have made an informed decision to decline immunisations, and, families who despite being offered support have not met the target timeline, the result is not surprising,” Mrs McDonald says.

Meanwhile, Mrs McDonald is delighted that for a third quarter in a row, Whanganui exceeded the 90 percent national target for More heart and diabetes checks by one percent. She says this is down to the dedicated efforts of general practice teams and the Whanganui Regional Health Network’s success in targeting patients who have not had a completed cardiovascular disease risk assessment.
 
Mrs Patterson is pleased with the steady progress being made on the new 85 percent Faster cancer treatmenttarget. This quarter’s 67 percent result is a five percent improvement on the 62 percent result achieved in the October to December quarter. The target asks that 85 percent of patients will receive their first cancer treatment (or other management) within 62 days of being referred as having a high suspicion of cancer. The target will increase to 90 percent by June 2017.

Click here for the full National Health Targets results table for 2014/15 Quarter 3.

Integration efforts across the Canterbury Health System remain pivotal to Canterbury District Health Board's performance in meeting health targets.

The National Health Targets performance summary quarter three results for 2014/2015 show Canterbury has exceeded the Shorter Stays in ED target achieving 96 percent despite increasing demand and capacity restraints within the hospital.

David Meates, Canterbury DHB chief executive, says the "remarkable" result represents the ongoing integration of services across the health system, particularly for older people to help them stay well in their own homes for longer.

"Although attendance has grown continuously since the February 2011 earthquakes, we are seeing little growth among the older population, which is a reflection of the strategies to care for older people in their own homes and communities being well embedded," Mr Meates says.

He says the biggest growth in attendances remain the younger adult population where there's been a 46 percent increase in non-enrolled patients aged 25-29 presenting to ED.

"We have increased focus on capturing home addresses appropriately and ensuring this group are provided with the right information on where to access primary care rather than defaulting to ED."

Primary care efforts particularly from the 24 Hour Surgery on Bealey Ave, Moorhouse Medical and Riccarton Clinic play a key role in the Canterbury Health System successfully managing acute demand. 

Other impressive results this quarter have been in our Improved Access to Elective Surgery delivering 100 percent of our target delivery (12,851 elective surgeries out of our 17,484 annual target).

"This is really outstanding given the theatre capacity constraints. It is a sign our priorities to improve patient flow, as well as ensuring we are tracking, monitoring and responding to any changes quickly, are working.

Performance exceeded the 'Better Help for Hospitalised Smokers to Quit' target where the Canterbury DHB achieved 97 percent of the 95 percent target.

"There's been a big emphasis on staff education, documentation and referrals. Hospital staff are also being supported to take on roles to support smoking cessation previously held by the Smokefree control team."

Quarter three has been a first for Canterbury in achieving the Increased Immunisation target of immunising 95 percent of eligible children.

"Low opt-off decline rates have contributed to this quarter's performance as well as targeted efforts by primary care."

Canterbury DHB continues efforts towards the meeting the Primary Care Health Targets of Better Help for Smokers (83 percent) and More Heart and Diabetes Checks (78 percent).

"We are committed to working closely with our Primary Health Organisations to actively support the delivery of primary care Health Targets. Initiatives include ongoing education, enhanced clinical engagement, and supporting high risk populations."

*Canterbury received an achieved based on improvement against the quarter two results.  

More information about how Canterbury performed in the health targets can be found on our website.

The West Coast health system has improved its performance in most of the Government’s health target categories thanks to efforts of teams across the Coast health system.

West Coast District Health Board Chief Executive David Meates says the performance improvements across the various targets have resulted from the health system working together on the areas that needed more focus.  A greater awareness of programmes designed to help people take responsibility for their own health has also played a part.

In the emergency department target which requires 95% of patients to be admitted, discharged or transferred from an emergency department within six hours, the West Coast DHB has scored an impressive 99.4%.

The West Coast’s elective surgery target is to deliver 1592 surgeries during the year ending June 30.  The DHB is tracking at 111.3% with 1288 elective surgeries delivered to date.

“With our smoking cessation advice and services, we have met both hospital and primary care targets this quarter.  West Coast DHB staff provided 97.8% of hospitalised smokers with smoking cessation advice and support – exceeding the 95% target with our best result yet,” Mr Meates says.

West Coast Primary Health Organisation Executive Officer Helen Reriti says general practices have reported giving 4,575 smokers advice about stopping, in the 12 months ending March 2015, representing 94% of smokers expected to attend general practice during the period.

“It’s particularly pleasing to have exceeded the 90% target for the first time.  Our clinicians have made huge efforts to tackle this issue, alongside the introduction of new technology to support their initiatives,” Ms Reriti says.

“Likewise, with 90.3% we have met for the first time the 90% target of ensuring the eligible enrolled West Coast population have had a cardiovascular risk assessment in the last five years.  That represents a 7.6% increase on our figures for the last quarter,” she says.

The range of approaches used to increase performance included identifying cardiovascular risk assessment champions within general practices; nurse-led clinics in practices; evening clinics and protected appointment time allocations for checks; Poutini Waiora nurses collaborating with general practices; conducting checks at local events; and using technology to remind patients.

High opt-off and declines continue to be challenging in meeting the immunisation target (95% nationally).  On the West Coast 89% are being immunised, however, we are reaching 100% of “high deprivation children” and 93% of all Maori children. 

This is the second time DHBs have been assessed against the new cancer treatment target and 62.5% of West Coast DHB patients received their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer.

Mr Meates says the Coast’s small population poses a challenge in this area. 

“We are missing this target by just one patient. But work is ongoing to improve the capture and quality of the Faster Cancer Treatment data which will improve our performance over the next few quarters.” 

Full information on the West Coast DHB’s Health Target performance can be found here, and information on the Ministry of Health’s Health Targets site here.

The results for Quarter Three of 2014/15 have been released by the Ministry of Health.

Results indicate that in this quarter, the Taranaki DHB has performed well in improving access to elective surgeries. With results ahead of the national average, the DHB is also paving the way towards the new faster cancer treatment goal, currently ranking fourth in the country for this target. Taranaki DHB has also achieved its target of 95 percent for shorter stays in Emergency Departments.

Taranaki DHB Planning, Funding, and Population Health General Manager, Becky Jenkins said, “A focus on the six key areas is important to continue to improve health, reduce inequalities and improve the quality of health services for local people. This quarter’s results have seen Taranaki DHBs maintain performance in a number of areas.”

Taranaki DHB Chief Operating Officer Gillian Campbell said, “In terms of our hospital services, the results show people in Taranaki have improved access to elective surgery and that we are working hard to ensure patients referred with a high suspicion of cancer are treated in a timely manner.”

The health target results for Taranaki DHB are:

Shorter stays in Emergency Departments: Target 95%, Achieved 95%
95 percent of patients seen in Taranaki Emergency Departments were admitted, discharged, or transferred from the department within six hours.

This result can be attributed to Taranaki DHB and Midland Health Network, the network of 99 percent of General Practitioners (GPs) in Taranaki, working closely together to ensure patients receive the right care, at the right place. That is, the Emergency Department for all emergencies, and their GP for other non-urgent medical needs.

The target was achieved nationally for the first time against a continuing increase in the number of emergency department presentations with 4,481 more people attending this quarter when compared to quarter two.

Improved Access to Elective Surgery: Target 100%, Achieved 120%
Taranaki DHB has again achieved over the target of 100% (for the population) for the improved access to elective surgery target, with a 4 percent increase from quarter two 2014/2015 results. Taranaki DHB has delivered this across a wide range of surgical specialities and is ranked second for its performance.

Assisting in this result has been an ongoing focus on ensuring patients are well prepared for surgery, and a continued reduction in day-of surgery-cancellations. Taranaki DHB is also undertaking a project to increase the surgical day procedure rate. This project is supported by the Ministry of Health.

Significant benefits also continue to be realised from the implementation of the Enhanced Recovery After Surgery (ERAS) programmes.

The national elective surgery health target has been achieved with 123,585 elective surgical discharges provided, against a year-to-date target of 115,588. This is 7997 (6.9 percent) more than planned.

Faster Cancer Treatment: Target 85%, Achieved 72%
This is the second quarter of public reporting of the new faster cancer treatment health target results. Nationally, results increased by 1.6 percent compared with the previous quarter to 67.4 percent overall. Data includes patients who received their first cancer treatment between October 2014 and March 2015. No DHBs have met the 85 percent target.

Taranaki DHB plans to continue this strong performance, and its collaborative relationship with the MidCentral DHB, to continue to work towards the target.

The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016, increasing to 90 percent by June 2017. Results cover those patients who received their first cancer treatment between July and December 2014.

Increased Immunisation: Target 95%, Achieved 91%
This quarter, 91 percent of Taranaki eight-month-olds were fully immunised. This is a decrease of 2% from the last quarter. These results are in line with historical expectations for quarter three because of the difficulty in vaccinating children during the summer holidays.

Nationally, the increased immunisation health target, national coverage at eight months was 92.9 percent, an overall decrease of 0.6 percent compared with the previous quarter but 1.5 percent higher than the same quarter in 2013/14.

Taranaki DHB has worked closely with primary care organisations, hospital services, outreach immunisation services, the National Immunisation Register and Well Child Providers on strategies to help improve our immunisation uptake, including early enrolment of new-borns with a GP.

A high level of immunisation coverage (around 95%) is required to prevent community spread of two common infectious diseases - measles and whooping cough. Taranaki DHB and the wider sector are working together to increase activity through to June 2015, with the aim of reaching the 95% target.

Better Help for Smokers to Quit (Hospital Target): Target 95%, Achieved 94%
Taranaki DHB continues to work hard to ensure patients and visitors to its hospitals are given advice about quitting smoking. By supporting smokers to quit, the aim is to improve the health of those around them by reducing exposure to second hand smoke.

A national total of 31,522 hospitalised smokers were offered brief advice and/or cessation support during quarter three, out of a possible 32,980.

Better Help for Smokers to Quit (Primary Care Target): Target 90%, Achieved 86%
Taranaki DHB is committed to working collaboratively with our Primary Care Organisation to continue to strengthen and implement a range of good practices to ensure all patients who smoke are offered or given effective stop smoking support.

More Heart and Diabetes Checks: Target 90%, Achieved 91%
This quarter, 91 percent of the eligible population had heart and diabetes checks. This is a one percent increase on Taranaki’s quarter one results.

Diabetes and cardiovascular disease remains one of the main causes of ill health in Taranaki and Taranaki DHB continues to work hard to provide the best outcomes for these people.

The implementation of a multidisciplinary team to support the care provided by GP practices, and the ongoing education of GP’s and practice nurses in the care and management of diabetic patients in the community, are just two examples.

Results show there were approximately 150,600 more checks provided in the five years to the end of March 2015 compared with the five years to the end of March 2014.

Nearly 500 more people were admitted, discharged or transferred within six hours of presenting to Wellington Hospital’s emergency department between January and March this year, an increase of three percent from the previous three months.

Latest health target results released today show that despite another record increase in the number of presentations to the emergency department in the first quarter of 2015, Capital & Coast District Health Board (CCDHB) has improved its performance against the shorter stays in emergency departments target, and three of the five other targets.

“These results reflect the improvements we’ve made to change how we care for people in hospital and the community, and the tremendous efforts made by our staff to provide high-quality healthcare for our patients,” says chief operating officer Chris Lowry.

“Elective surgery performance has improved and we are on track to meet the target this year as we have done in previous years,” she says.

The DHB is also providing more people with help to quit smoking, rising from 80% in the last quarter to 92% of patients provided with brief advice and support to quit this quarter.

“Quitting smoking is the single best thing a person can do for their health. While we have some more work to do in this area to achieve the target, it is promising to see we are supporting more of our patients to do this, especially at the primary care level,” she says.

CCDHB continues to lead the country in the new Faster Cancer Treatment target, and achieved the national immunisation target as second-highest performer.

“Our goal is to achieve all six targets. These latest results are very promising and reflect the amount of time and effort put in by our staff put in to date,” Ms Lowry says.

The results of the six national health targets across all 20 District Health Boards (DHBs) have been released today for the January to March 2015 quarter.  We sustained our improvements to achieve the goals again this quarter for Shorter Stays in the Emergency Department, and Better Help for Smokers to Quit for patients admitted to hospital.  A summary of our results for all the national health targets this quarter is provided below.

Just under 96% (9520) of 9961 people were admitted, discharged or transferred from the Emergency Department (ED) within six hours of presenting – A small improvement on last quarter and again achieving the national target.  Compared to the same quarter last year when we had a similar number of people presenting to the Emergency Department, 559 more people had shorter stays in ED this quarter – a sizeable improvement that reflects the concerted effort of a large number of staff to ensure better patient flow processes, and, together with our general practice teams, better manage the demand for acute health care services.

We continue to be ahead of target for the number of people discharged following their elective surgery.  Over this quarter, another 1701 patients were discharged following their elective surgery bringing the total number to 5377 patients who have had their elective surgical procedure over the last nine months – delivering 110% of our planned target year to date.  About 11% of our patients have their planned surgery at other hospitals that provide specialist surgery to residents of the wider region, like Wellington for heart surgery, and Hutt Valley for plastic and burns surgery.

The new national target for faster cancer treatment was published for the first time last quarter.  The target is that by July 2016, 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.  Our result this quarter, at 67%, is consistent with last quarter and the same as the national average for this period (results cover those patients who received their first treatment between October 2014 and March 2015).  This target focuses on a sub-set of patients who are referred through a managed, outpatient pathway.  Our aim is to make steady improvements toward this target by examining referral guidelines and pathways to earlier diagnosis and treatment that will ultimately benefit all cancer patients.

The hospital component of the national health target for offering advice and support to quit smoking was achieved for the second consecutive quarter, with a result of 97.0%.  This was a small improvement on the result last quarter and just above the national average (96%).  Of the adult patients admitted to hospital who smoke (about 15% of all admissions), 1111 patients have been offered brief advice and support to quit smoking over the last nine months.

The result for providing better help for smokers to quit in the primary healthcare setting could not be reported in time for publishing this quarter.  This was disappointing, especially as the targeted ‘quit smoking’ campaign that was undertaken over the last few months by our primary health organisation (CentralPHO) and general practice teams is likely to have contributed to a big improvement on our previous results.  We are currently verifying the data and expect that updated data will be published on the health targets website within the next week or so.

Our result for eight-month-old infants being fully immunised on time fell slightly this quarter to 94.4% - just short of the 95% target, which we attained last quarter.  A drop in the rate this quarter is similar to the pattern last year, with the summer holiday period making it a bit more difficult to reach families with infants due for their immunisation.  Our immunisation team, including general practices and outreach services, continue to work together with families to ensure the vast majority of our children are immunised against vaccine preventable diseases.

The proportion of our eligible enrolled population that have had their risk for cardiovascular disease assessed in the last five years was much the same as last quarter.  Although there were another 367 heart and diabetes checks undertaken between January and March, the proportion of the total expected number to have had a risk assessment over the last 12 months fell short of the 90% target, at 85% of the 47,260 eligible enrolled adults.  CentralPHO is continuing to support general practice teams and our Maori and Pacific health providers to enable more people to have a heart and diabetes check to minimise the risk of them having a heart attack or stroke in the next five years.

Chief executive officer Kathryn Cook has thanked staff for their continued efforts to improve on our performance against these targets.

For more details and FAQs about the Health Targets go to: www.health.govt.nz/healthtargets and the 'MyDHB' website.

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

• 96 per cent of smokers in hospitals were offered advice on how to quit.
• DHBs delivered 7,997 more elective surgical discharges than planned.

“DHBs remain focused on reducing waiting times for elective first specialist assessments and treatment,” says Dr Coleman.

“The extra $98 million for elective surgery in Budget 2015 will provide more New Zealanders with timely surgery. The Government is committed to continuing to deliver increases in elective surgery.”

The results also show good progress on other targets, including:

• The more heart and diabetes checks target increased to 88 per cent.
• The primary care component of the better help for smokers to quit target increased to 89 per cent.
• The new faster cancer treatment health target increased to 67 per cent – this is the second time this target has been reported.

The quarter three (January-March 2015) results can be found at www.health.govt.nz.

The results of district health board performance against six health targets for the third quarter 2014/15 has been released.

The results are available at:  http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15

• bring together health practitioners, health consumers and policy makers
• review the role of screening in the control of cancer
• review the potential benefits and potential risks of cancer screening
• explore the future of cancer screening and primary prevention in New Zealand
• share knowledge and foster debate.

Topics include cervical, breast and colorectal cancer screening as well as the potential for primary prevention of these cancers.

Forum speakers include Sue Claridge, Associate Professor Brian Cox, Sarah Derrett (Beat Bowel Cancer Aotearoa), Dr Hazel Lewis, Dr Susan Parry, Professor John Potter, Professor Ann Richardson and Associate Professor Diana Sarfati. 

The forum is organised by the Auckland-based Cartwright Collective in association with the Auckland Women’s Health Council and Women’s Health Action.

Cost: $150 ($80 for consumers).

To find out more and for registration details, go to:  http://www.eventbrite.co.nz/e/the-future-of-cancer-screening-in-new-zealand-tickets-16706180636

Original Health Navigator NZ material is produced and updated by a team of medical writers and subject experts.

The Health Navigator NZ website is a non-profit community initiative combining the efforts of a wide range of partner and supporter organisations overseen by the Health Navigator Charitable Trust.

An immunotherapy technology for treating cancer and other diseases, jointly developed by Victoria University of Wellington’s Ferrier Research Institute and the Malaghan Institute of Medical Research, has been patented and will be the initial focus of a newly-formed company.

Equity investment for the company, called Avalia Immunotherapies, is coming from New Zealand investment firm Powerhouse Ventures, the New Zealand Venture Investment Fund, Malcorp Biodiscoveries Limited and Victoria Link Limited (Victoria University’s commercialisation office). Additional support is also coming from Callaghan Innovation’s technology incubator programme, in the form of a repayable grant, and the Kiwi Innovation Network.

The director of the Ferrier Research Institute, Professor Richard Furneaux, says Avalia Immunotherapies will further develop the ground-breaking technology and aims to progress it to clinical trials.

The research has been led by Dr Gavin Painter from Ferrier Research and Dr Ian Hermans from the Malaghan Institute, and works as a therapeutic vaccine, activating a patient’s own immune system to recognise and attack cancer cells.

Avalia Immunotherapy’s chief executive, Dr Shivali Gulab, says the decade-long research partnership between Dr Hermans and Dr Painter has led to a powerful technology platform that has been patented and licensed to the company for commercial development.

“The technology can be used to design new treatments for cancer, as well as infectious disease and allergy. Our initial focus will centre on cancer immunotherapy.”

Professor Furneaux says the potential benefits of the therapy are huge, not only for cancer patients but for the Wellington research community. “I’ve worked in this field since 1980 and this is the first time I’ve been involved in placing our intellectual property in a New Zealand start-up company—that’s how important this research is.

“This is also the beginning of what we hope is a birth of a biomedical initiative for the Wellington region—there’s fantastic biomedical infrastructure here, from research facilities to the excellent District Health Boards. We’re hoping Wellington will become just as well known for its biomedical research as it is for its film industry.”

Budget 2015 invests $12.4 million to extend the Waitemata District Health Board’s bowel cancer screening pilot to December 2017, Health Minister Jonathan Coleman says.

“A colonoscopy can identify whether a person has cancer or pre-cancerous growths. Bowel cancers found and treated early can save lives,” he says.

“More than 6,000 people have received a colonoscopy through the $24 million bowel screening pilot since January 2012. Early results from the pilot are positive and it is providing valuable information for the potential roll-out nationally.

“The Government is considering the next steps for a national bowel screening programme. The largest constraint is having the workforce to do the colonoscopies. There are a number of initiatives under way to address this.”

An additional $8 million was provided in Budget 2014 to help DHBs deliver more colonoscopies. New figures show that significantly more people are now receiving publicly funded colonoscopies, and waiting lists are dropping.

“Over 35,800 people received a colonoscopy last year, up from over 29,000 in 2013. That’s an increase of more than 20 per cent,” Dr Coleman says.

“Nationally, the number of people waiting for a colonoscopy has dropped by over 30 per cent in the past 12 months. This is a significant achievement.

“DHBs are working hard to manage their endoscopy services, and this is now paying real dividends. There are still challenges ahead, however, including further increasing the workforce capacity.” 

Initiatives to strengthen the endoscopy workforce include increasing the number of gastroenterology trainees. The sector is also considering increasing the use of CT colonography where appropriate.

This Account focuses on the quality of services Hutt Valley DHB provided during 2013/2014.

Contents include: Health targets; Quality & safety markers; Serious adverse events; Patient experience Receiving care closer to home; Getting in shape before joint surgery; Getting better at home; Helping cancer patients find their way; Encouraging attendance; Community Safety Initiatives HealthPathways; More heart and diabetes checks; Help quit smoking; Disability services; Empowering staff; Giving babies the best possible start; Patient safety initiatives; Open campaign; Care capacity demand management; Electronic whiteboard; Newborn hearing screening; Malnutrition screening & training; Supervisor training; Looking forward; Future Focus.

This Quality Accounts is available to read in full text at:  http://www.huttvalleydhb.org.nz/content/10ff5f6d-fe7e-4a44-8667-5b72672d3214.html

The authors used data from the Netherlands to evaluate the impact of vaccination against HPV types 16 and 18 on the burden of anal, penile, and oropharyngeal carcinomas among heterosexual men and men who have sex with men. The reduced transmission of vaccine-type HPV from vaccination of girls was assumed to lower the risk of HPV associated cancer in all men but not to affect the excess risk of HPV associated cancers among men who have sex with men.

Before HPV vaccination, 14.9 (95% credible interval 12.2 to 18.1) quality adjusted life years (QALYs)  per thousand men were lost to vaccine preventable cancers associated with HPV in the Netherlands. This burden would be reduced by 37% (28% to 48%) if the vaccine uptake among girls remains at the current level of 60%. To prevent one additional case of cancer among men, 795 boys (660 to 987) would need to be vaccinated; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2162, 3486, and 1975, respectively. The burden of HPV related cancer in men would be reduced by 66% (53% to 805) if vaccine uptake among girls increases to 90%. In that case, 1735 boys (1240 to 2900) would need to be vaccinated to prevent an additional case; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2593, 29107, and 6484, respectively.

The authors conclude that men will benefit indirectly from vaccination of girls but remain at risk of cancers associated with HPV. The incremental benefit of vaccinating boys when vaccine uptake among girls is high is driven by the prevention of anal carcinomas, which underscores the relevance of HPV prevention efforts for men who have sex with men.

This is an open access article and can be read in free full text at:   http://dx.doi.org/10.1136/bmj.h2016

Bogaards, J.A., et al. (2015). Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: Bayesian evidence synthesis. BMJ, 350:h2016.

To find out more about the campaign, go to:  http://www.cdc.gov/cancer/breast/young_women/bringyourbrave/index.htm

This 2014 report Diet, nutrition, physical activity  and liver cancer, is a rigorous, systematic, global analysis of the scientific research currently available on liver cancer and how certain lifestyle factors affect the risk of developing the disease.

This evidence briefing, Supporting self-management: Helping people manage long-term conditions, has been produced by the Centre for Reviews and Dissemination.

"The study focuses in on the content of these new models, which are frequently applied from different disciplinary and professional perspectives and associated with different goals and does so through analyzing approaches to self-management support, service delivery design and decision-support strategies, financing, availability and access. Significantly, it also illustrates the challenges faced by individual patients as they pass through the system".

The book is free to download at:  http://www.euro.who.int/en/about-us/partners/observatory/publications/studies/assessing-chronic-disease-management-in-european-health-systems-country-reports

Nolte, E. & Knai, C. (2015). Assessing chronic disease management in European health systems: Country reports. Brussels: European Observatory on Health Systems and Policies.

The authors electronically surveyed clinicians from the College of Emergency Nursing Australasia, Australian College of Emergency Nursing and Australasian College for Emergency Medicine working in an Australian ED.

Respondents were 444 doctors and 237 nurses. They reported overcrowding, noise, lack of time and privacy as barriers to care. Most (93.3%) agreed/strongly agreed that the dying patient should be allocated private space in ED. 73.6% (451) felt unable to provide a desired level of care to advanced cancer patients in ED. Clinician attitudes were affected by staff type, experience, ED demographic and hospital type, but not education in palliative care.

The authors conclude that ED environments place pressure on clinicians delivering care to people with advanced cancer. They suggest that integrating palliative care services in ED and redesigning EDs to better match its multifaceted functions should be considered.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12245-015-0061-8

Weiland, T., et al. (2015). Managing the advanced cancer patient in the Australian emergency department environment: Findings from a national survey of emergency department clinicians. International Journal of Emergency Medicine, 8:14.

This meeting will bring together scientists, clinicians and health professionals with a wide-ranging focus on conditions affecting the digestive tract with an opportunity to discuss an interwoven theme of the role of the intestinal microbiota. 

To find out more about this event, go to:  http://asmr-nsc.org.au/

The journal is divided into three sections:

• Clinical Radiation Oncology
• Radiation Biology and Molecular Radiation Oncology
• Radiation Physics

The review broadens the work of other similar reviews by focusing on effectiveness of healthcare practice as well as health outcomes associated with implementing a chronic care model. In addition, relevant case series and case studies were also included.

Of the 77 papers which met the inclusion criteria, all but two reported improvements to healthcare practice or health outcomes for people living with chronic disease. While the most commonly used elements of a chronic care model were self-management support and delivery system design, there were considerable variations between studies regarding what combination of elements were included as well as the way in which chronic care model elements were implemented. This meant that it was impossible to clearly identify any optimal combination of chronic care model elements that led to the reported improvements.

While the main argument for excluding papers reporting case studies and case series in systematic literature reviews is that they are not of sufficient quality or generalizability, the authors found that they provided a more detailed account of how various chronic care models were developed and implemented. In particular, these papers suggested that several factors including supporting reflective healthcare practice, sending clear messages about the importance of chronic disease care and ensuring that leaders support the implementation and sustainability of interventions may have been just as important as a chronic care model’s elements in contributing to the improvements in healthcare practice or health outcomes for people living with chronic disease.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0854-8

Davy, C., et al. (2015). Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Services Research, 15:194.

A team of specialist cancer researchers have joined forces to focus on the impact of obesity on breast cancer.

The researchers all work at the University of Otago, Christchurch’s Mackenzie Cancer Research Group. The Group is headed by Canterbury District Health Board oncologist Professor Bridget Robinson, a breast cancer expert.

Researchers Associate Professor Gabi Dachs, Dr Margaret Currie and Dr Logan Walker have previously investigated various aspects of cancer but decided to team up and focus on the significant health issue of obesity.

Associate Professor Dachs says that international studies have shown breast cancer patients who were obese before or after diagnosis are less likely to survive than patients with normal BMI. Risk of dying from breast cancer increases by a third for every increment of 5kg/m2 in BMI.

The three researchers are investigating different aspects of obesity and breast cancer:

Associate Professor Dachs is looking at molecular factors associated with obesity in cancer, particularly how fat cells communicate with cancer cells and negatively affect them.
Dr Margaret Currie is putting fat and breast cancer cells together to see how the fat cells make tumours more resistant to treatment. She suspects the fat cells provide ‘an extra energy hit’ to cancer cells by providing lipids, or fats, in addition to glucose.
Geneticist Dr Logan Walker will investigate whether the obesity-related gene responsible for the amylase enzyme in saliva (AMY1) contributes to breast cancer development. He will also explore the role of key genes that behave differently in breast tumours from obese women.

A UK population-representative sample of greater than or equal to 50 year-olds (n=6965) was surveyed using the Awareness and Beliefs about Cancer measure. These analyses examine six items on cancer beliefs (e.g., ‘cancer can often be cured’), and four on help-seeking barriers (e.g., ‘I would be too embarrassed’).
results: Smokers were more likely to hold pessimistic cancer beliefs than never-smokers or former-smokers on four of six items. For example, 34% agreed ‘a cancer diagnosis is a death sentence’, compared with 24% of non/former-smokers (P<0.001).

More smokers (18%) than non/former-smokers (11%) would not want to know if they had cancer (P<0.01). The only barrier to symptomatic help-seeking differing by smoking status was ‘worry about what the doctor might find’ (36% vs 28%, P<0.01). Associations were independent of demographics, self-rated health and cancer experience.

The authors conclude that smokers held more pessimistic and avoidant beliefs about cancer, which could deter early-detection behaviour. A better understanding of these beliefs is needed to increase engagement in early diagnosis by this high-risk group.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1038/bjc.2015.148

Quaife, S.L., et al. (2015). Smoking is associated with pessimistic and avoidant beliefs about cancer: results from the International Cancer Benchmarking Partnership. British Journal of Cancer, 112, 1799–1804

Health Minister Jonathan Coleman says two new sector-based cancer leadership roles will ensure patients receive even better support and care.

Clare Greensmith has been appointed National Lead for the cancer psychological and social support workforce initiative, and Heidi Watson takes up the role of Clinical Leader, Adolescent and Young Adult Cancer Network Aotearoa.

“Budget 2014 provided an additional $4.5 million a year for improved psychological and social support for cancer patients,” says Dr Coleman.

“The new national lead will assist DHBs to employ a psychologist in each of the six regional cancer centres, and up to 20 new cancer psychological and social support workers across the country.

“These new roles will help to ensure that the psychological and social needs of cancer patients and their families are properly assessed, and they have access to appropriate support and counselling.”

In 2013 an additional $650,000 was invested to support improved adolescent and young adult cancer services, including the establishment of the Adolescent and Young Adult (AYA) Cancer Network Aotearoa.

“Adolescence can be a challenging time of life for young people and their families, without the added stress of dealing with cancer,” says Dr Coleman.

“A new clinical leader role has been created to support the development of the AYA Cancer Network Aotearoa, and to help shape future services for young people affected by cancer. We want to ensure that young people have access to high quality services no matter where they live.”

Notes:

Clare Greensmith is a registered psychotherapist and a registered occupational therapist. She has extensive experience in service development and management, including the development and management of support services at Otago Community Hospice. She also has clinical experience of working with people with cancer.

Heidi Watson takes up the role of Clinical Leader for Adolescent and Young Adult Cancer Network Aotearoa from her current position as a clinical nurse specialist in adolescent and young adult cancer at Auckland DHB.

The campaign eschews the gruesome imagery of previous advertisements to focus on the way the quality of life of cancer sufferers is affected".

To read the full story in The Age, go to:  http://www.theage.com.au/victoria/new-quit-campaign-highlights-16-cancers-associated-with-smoking-20150503-1myydi.html

To find out more about the campaign, go to:  http://www.quit.org.au/reasons-to-quit/health-risks-of-smoking/16-cancers

http://www.nzsoncology.org.nz/conference

They present three themes: "decision hierarchy in health care, meanings of ‘home’, and late recognition of dying. Based on the detailed findings, this paper suggests that important insights into the broader goals of advanced cancer patients are offered by allied health staff, and that more effective use of the multidisciplinary team may support endeavours to achieve more home deaths for cancer patients who want this outcome. The analysis also provides new insights into the meaning of ‘home’ in interactions between advanced cancer patients and health professionals. The wish for ‘home’ appears bound up with other patient goals and the implications of this are discussed".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/ecc.12295 or contact your DHB library, or organisational or local library for assistance.

Bostanci, A., Horey, D., Jackson, K., William, L., Pittmann, L., Ward, J., Moore, G., Martin, P., Hudson, P. and Philip, J. (2015), Insights into hospitalisation of advanced cancer patients: A study of medical records. European Journal of Cancer Care, 22 April [Epub before print] 

In the latest issue (attached below):

A MAMAgram – is that like a Strip-a-gram? Radio adverts playing on The Hits and Coast around Waikato at the moment pose that interesting question. The answer? Well….no.

A Waikato promotion campaign was launched this week using Facebook and radio to encourage daughters to speak to their mothers about breast screening mammogram checks – and gives them the chance to win prizes.

It centres around a Facebook page My MAMAgram (www.Facebook.com/mymamagram) aimed at Waikato women who are not yet enrolled in the national breast screening programme or who have not had a mammogram in the past two years.

A mammogram is a simple, free digital x-ray of both breasts to look for any early signs of breast cancer. All women who are eligible for public health services and between 45 and 69 years old can get a free mammogram every two years.

“We have taken a fresh approach to this campaign to reach out to these women and their daughters so they see breast screening in a different light,” said Waikato DHB screening services manager Clare Coles.

That approach involves a good-humoured radio adverts playing on The Coast and The Hits (click on the play button under the featured photo), plus social media postings, a selfie competition and a prize-winning random draw for all eligible Waikato women who have a mammogram between 20 April and 20 June.

She said the rates for mammograms in the Hamilton area were lower than for other parts of the Waikato, and Maori and Pasifika women also have lower rates. “We have two screening sites available at Anglesea Women’s Clinic and Waiora Waikato hospital campus for women who live or work in the Hamilton area.

“All they need to do is ring 0800 270 200 to enrol or book an appointment.”

BreastScreen Midland provides breast screening to eligible women living in the Waikato, Lakes and Bay of Plenty district health board areas.  Rural areas are well served by mobile screening units on scheduled visits. To find out where you can go for a mammogram, anywhere it New Zealand, visitwww.nsu.govt.nz/breastscreen-aotearoa/where-have-mammogram

Many women put off having a mammogram because they fear the results or have heard that it hurts. In some cases they feel awkward about exposing their breasts to someone they don’t know.

“Through this campaign we can reassure them what really happens in a mammogram and that their privacy is very much respected. Our staff are wonderful and the process is all over in 10 minutes. You can bring someone along with you – perhaps a friend or a daughter – if that makes it easier.”

For some women it can be sore for a moment, but for many it is just a little bit uncomfortable, that’s all.

“Knowing you are clear of breast cancer is peace of mind for a woman and her family. If something is picked up, it can be dealt early on with a much better rate of successful treatment,” Clare Coles explained.

Of every 1000 women aged 50 to 69 in the national breast screening programme, about 950 will get a clear result, two thirds immediately and the rest after some further assessment.

https://www.gov.uk/government/publications/choice-in-end-of-life-care

In the latest issue (attached below):

After a decade of discovery and research, two University of Auckland medical oncology researchers along with their dedicated teams have developed a new anti-cancer compound that will advance to human phase two clinical trials.

The co-inventors of the compound TH-4000, Dr Adam Patterson and Dr Jeff Smaill, senior academics from the Auckland Cancer Society Research Centre and the Maurice Wilkins Centre, have collaborated with a NASDAQ-listed American bio-technology company, Threshold Pharmaceuticals, to advance the compound to this stage.

TH-4000 is described by Threshold as a molecular-targeted, hypoxia-activated irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that may overcome resistance to therapy from conventional EGFR-TKI compounds.

The data was reported today at the annual meeting of the American Association for Cancer Research (AACR) in Philadelphia by Drs Patterson and Smaill.

“We are grateful for the funding support from the Ministry of Business Innovation and Employment, the Health Research Council of New Zealand and the Maurice Wilkins Centre over the years,” said the co-inventors, Drs Patterson and Smaill.

In September 2014, Threshold licensed exclusive worldwide rights to a clinical development program based on TH-4000 from Auckland UniServices, the technology transfer company of the University of Auckland.

The new compound has shown positive results in limiting tumour growth in Non-Small Cell Lung Cancer (NSCLC) models resistant to conventional EGFR-TKIs.

“Certain tumour types are addicted to EGFR signalling and current EGFR-TKI therapies are ineffective in shutting down that signalling due to dose-limiting toxicities of rash and diarrhoea,” says Dr Adam Patterson, head of the Translational Therapeutics Team at the University’s Auckland Cancer Society Research Centre (ACSRC).

“At the same time, we know that these tumours are hypoxic, and that hypoxia drives the overexpression of EGFR, “he says. “Therefore, a molecularly-targeted, hypoxia-activated irreversible EGFR-TKI is expected to deliver greater efficacy with fewer side effects than available treatments.”

His co-inventor, Dr Jeff Smaill, a senior medicinal chemist at the University of Auckland, says “Leveraging knowledge that the hypoxic tumour microenvironment enhances aberrant, wild-type EGFR signalling, we designed TH-4000 to selectively release an irreversible EGFR inhibitor upon encountering tumour hypoxia.”

“Given Threshold’s expertise in developing therapies that target tumour hypoxia, it’s exciting for us to be working together on this next generation approach of combining molecular and hypoxia targeting in a single drug candidate,” he says.

Aberrant EGFR signalling is implicated in the growth and spread of certain tumour types including NSCLC and Head and Neck cancers. Clinical studies indicated that mutant EGFR-positive NSCLC with wild-type EGFR present (heterozygous) was associated with reduced response rates, progression free survival and overall survival outcomes on conventional EGFR-TKIs.

In Head and Neck cancer, wild-type EGFR signalling drives tumour growth. Both types of tumours are known to be hypoxic; thus, hypoxia-induced activation of wild-type EGFR signalling may be a mechanism of EGFR-TKI resistance.

Data from a previous Phase 1 clinical trial of patients with advanced solid tumours were also reported at the AACR. The maximum tolerated dose of TH-4000 administered as a 1-hour weekly intravenous infusion was established at 150 mg/m².

The most common treatment-related adverse events were dose-dependent and included rash, QT prolongation, nausea, infusion reaction, vomiting, diarrhoea and fatigue.

"We believe the data presented at AACR support our clinical development plans for TH-4000 in patients with tumours that are not candidates for conventional EGFR-TKI therapy," says Dr Tillman Pearce, Chief Medical Officer of Threshold.

"In particular, we believe the data support the development of TH-4000 in patients with mutant EGFR-positive, T790M-negative NSCLC after conventional EGFR-TKI therapy has failed as well as in patients with head and neck cancer for which EGFR over-expression is associated with worse outcomes, both of which represent a significant unmet medical need.”

“We are delighted to join forces with our friends and experts in the field of tumour hypoxia and Hypoxia-Activated Prodrug technology at the University of Auckland, and look forward to our collaborative efforts in the development of TH-4000 as a potential new therapy that has potential to overcome the limitations of currently available EGFR-TKI therapies,” says Dr Pearce.

Thirteen studies were added in this update, giving a total of 47 randomised controlled trials, with 2985 participants included in the data analyses. The studies focused on six chronic illnesses (painful conditions, cancer, diabetes, asthma, traumatic brain injury and eczema) and evaluated four types of psychological therapies (cognitive behavioural therapy, family therapy, problem solving therapy, multisystemic therapy). 

The authors conclude from their analysis that "there is little evidence for the efficacy of psychological therapies that include parents on most outcome domains of functioning, for a large number of common chronic illnesses in children. However, psychological therapies are efficacious for some outcomes. CBT [cognitive behavioural therapy] that includes parents is beneficial for reducing children's primary symptoms, and PST [problem solving therapy] that includes parents improved parent adaptive behaviour and parent mental health. There is evidence that the beneficial effects can be maintained at follow-up for diabetes-related symptoms in children, and for the mental health of parents of children with cancer and parents who received PST".

The authors suggest that the small number of studies in this review means that future studies are likely to impact on the findings.

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009660.pub3

Eccleston C, Fisher E, Law E, Bartlett J, Palermo TM. (2015). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews, 4, Art. No.: CD009660.

The cost of treating cancer in the New Zealand public health sector is more than $800 million annually – hundreds of millions higher than previous estimates, according to University of Otago research.

Researchers from the University’s Department of Public Health, based in Wellington, have used a new method to calculate the total cost of treating cancer in the public sector, including costs by cancer type.

They calculated that the total cost of treating cancer in the public health system was $880 million, which is 26 percent greater than the Ministry of Health estimate (of $526 million) for the same period (based on data collected between 2010 and 2011).

According to the research, the cancers that the most public health dollars are being spent on annually are: colon (15%); breast (14%); and prostate, non-Hodgkin lymphoma and leukaemia (each at 6%).

The researchers found the cost varied greatly by cancer type. Melanoma is one of the cheapest cancers to treat at $8000 per diagnosed and treated case, whereas leukaemia, which costs on average $95,000 a case, is the most costly.

The lead author of the study, Professor Tony Blakely, says while the amount of money spent per cancer case was about the same for women and men, there was a noticeable difference in terms of how much was spent based on patient age.

“For example we spend more on 45-year-olds than we do on 85-year-olds. This suggests that the health system is working even harder to save younger lives through more actively pursuing such treatment options as surgery, chemotherapy and radiotherapy.”

Professor Blakely says he supported the introduction of more preventative measures that targeted known cancer causes.

“New Zealand has done a good job in many areas of cancer prevention by increasing tobacco control through taxes and law changes, and by increasing the tax on alcohol. The introduction of anti-cancer vaccines for human papilloma virus (HPV) and hepatitis B, and occupational health strategies such as banning asbestos imports, are other preventative measures that are helping in the reduce the cancer burden but much more could be done – especially in accelerating progress towards achieving the Government’s smokefree goal by 2025.”

Professor Blakely says there is a need for a national bowel cancer screening programme, especially since such programmes have proved to be cost-effective internationally and because colon cancer was the most costly cancer type overall.

Study co-author, Associate Professor Nick Wilson, from the University of Otago, Wellington, says it makes sense to introduce preventive measures that target New Zealand’s obesity epidemic because it would lower the cancer burden and help curb the country’s burgeoning healthcare bill.

“There are things that can be easily done by taking the food industry to task on food labelling, portion size and advertising junk food to kids. Then there is the issue of taxing unhealthy food. Without a doubt the Government should be following other countries and looking at a tax on sugary drinks as a start. It would not only save in terms of obesity and cancer costs but help in the fight against diabetes – a particularly expensive disease.”

Studies in this issue (attached below):

To find out more about this event, go to:  http://www.esmo.org/Conferences/ESMO-Asia-2015-Congress

Eighteen studies were included (3 randomised controlled trials, 5 case-controlled studies and 10 case series) - 7 on gastric and 11 on oesophageal resection. 

Based on their analysis, the authors conclude that "the evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1308/003588414X14055925061630 or contact your DHB library, or organisational or local library for assistance.

Gemmill, E.H., et al. (2015). Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Annals of The Royal College of Surgeons of England, 97(3), 173-179.

PHARMAC will begin funding for the prostate cancer treatment abiraterone (Zytiga) from 1 May 2015, potentially benefiting up to 1000 men annually.

Prostate cancer is the most commonly-diagnosed form of cancer among New Zealand men. Funding for abiraterone will be for men with an advanced form of prostate cancer, called metastatic castration-resistant prostate cancer.

Men will be able to receive funded abiraterone tablets either before or after chemotherapy.

The funding comes as part of a multi-product agreement with Janssen, which includes the attention deficit hyperactivity disorder (ADHD) treatment Concerta; Topamax, a treatment for epilepsy; and Eprex, a treatment for anaemia.

Savings and rebates in the multi-product agreement have helped reduce the overall cost of abiraterone.

“PHARMAC is always looking to fund new treatments that provide health gains for patients,” says Director of Operations Sarah Fitt.

“Giving men an alternative to chemotherapy is a real benefit for them, and because it’s a tablet they won’t need to go to hospital to receive intravenous treatment.

“Clinical trials show abiraterone significantly improves the quality of life for men with advanced prostate cancer and extends life by around five months. That’s a real benefit for New Zealand men with advanced prostate cancer, a disease where current treatment options are limited.

“We’re pleased to be able to improve the outlook for men with this common cancer.” 

Comment on abiraterone funding

Prostate Cancer Foundation

Prostate Cancer Foundation Chief Executive Graeme Woodside says the Foundation is delighted with the decision by PHARMAC to approve the funding of abiraterone for patients with advanced prostate cancer.

Mr Woodside says abiraterone is one of the innovative new treatments becoming available for men with advanced prostate cancer. There has been concern that while funding for it was available in other countries, such as Australia, UK and Canada, New Zealand men were unable to access this as a funded medication and some men were paying up to $5000 per month to privately fund their treatment.

“The Prostate Cancer Foundation congratulates PHARMAC and the supplier, Janssen, on reaching agreement on a supply arrangement that will give access to this medication, and new hope, to men with late stage prostate cancer,” says Mr Woodside.

Prof Ross Lawrenson, Midland Prostate Cancer Research Group

“We are very pleased to see that PHARMAC has authorised the funding of abiraterone. Our research has shown that metastatic prostate cancer is commonly found at diagnosis in New Zealand men with over 300 new cases annually. Māori men are twice as likely to be diagnosed with metastatic disease.

“Abiraterone provides an additional treatment option for these men and has been shown in clinical trials to increase life expectancy over and above our current treatments. It also means that there is an alternative to the use of chemotherapy in those men who have become resistant to hormonal treatment.

“This will be of particular relevance to older men, those with co-morbidities and those living some distance from a cancer treatment centre who are less likely to be suitable for treatment with chemotherapy.”

NZBCF Counselling offers three free one-on-one professional counselling sessions to women at whatever stage of their breast cancer treatment they most need it.

To read the full media release from the New Zealand Breast Cancer Foundation, go to:  http://www.scoop.co.nz/stories/GE1504/S00001/free-breast-cancer-counselling-no-fooling.htm

Dr Gurney (Ngāpuhi, Ngati Hine) was awarded a 2014 HRC Eru Pōmare Research Fellowship in Māori Health to carry out his study of testicular cancer at the University of Otago, Wellington.

To read the full story, go to:  http://www.hrc.govt.nz/news-and-publications/news-media#exploring-nz's-puzzling-testicular-cancer-rates

This analysis outlines the clinical presentation and underlying causes of haematuria, and identifies interventions that could improve the pathway of care. Diagnostic options reflect the development of genomics as a diagnostic tool.

Feedback on this document is welcomed by the Committee.

For further information, including contact details for feedback, go to:  http://nhc.health.govt.nz/diagnostics-overview

Southern DHB is ‘Going Spotty’ this Friday (27th March) to raise awareness of Melanoma.

March is Melanoma Awareness month and the Melanoma Foundation is holding its third national ‘Go Spotty’ Mufti Daythis Friday to raise awareness of this disease that is affecting over 4000 kiwis every year.

The idea is to get everyone wearing something spotty or dotty to get people thinking about melanoma and checking their skin for ‘spots’ or signs that could lead to melanoma later on in life. Everyone who decides to ‘Go Spotty” can make a gold coin donation for the pleasure of wearing spotty mufti on the day.

Vicki Devery, Physiotherapist and Manual Handling Advisor at Southland Hospital came up with the idea of holding a ‘Go Spotty’ day at the DHB.

Vicki wanted to raise awareness of melanoma because she has had a melanoma which, thanks to early detection, has been successfully removed.

“In mid- 2013 I noticed a dark freckle on my left upper arm which had been there for while. I have lots of freckles so hadn’t thought much about it. After it became tender I visited my GP who removed the freckle,” said Vicki.

 A week later, the results came back as a diagnosis of stage II primary melanoma with the recommendation for a wide local excision. Vicki had the excision and now has six monthly checks.

“I have not thought about my skin as a potential health hazard so it has opened my eyes to thinking about my skin more.  I worry now when I see someone who is sun burnt, or sitting out in the sun with little protection.  I feel that if it can happen to me at the age of 30 then it can happen to anyone,” she said.

Vicki wanted to support and promote "spotty day" as a way of getting people to think about their skin and how they look after it, as well as people thinking about their families especially children.

“I would like people to be more proactive in checking their spots and determining what is normal for them so that they are aware of any changes and can then get these changes checked out by a GP.  If in doubt, get it checked out!”

Vicki is organising a display at Southland Hospital as well as encouraging wards and departments in the hospitals across the district to take part.  There are prizes of donated sunscreen for the best “Spotty” dressers, donated sunsmart swimwear for children as well as a melanoma quiz for staff with a prize of two beauty gift packs.

At Dunedin Hospital the oncology research team will be ‘Going Spotty’ and will have a display in the hospital foyer to raise awareness and also showcase important research they are carrying out into melanoma treatment.

“Melanoma is more common in New Zealand and Australia than any other country. The Oncology Research team at Southern DHB is working with partners at the University and in Industry to help develop new and more effective treatments for melanoma, and also to identify better ways of predicting if melanoma has spread. Melanoma is important for all New Zealanders, but for our team in particular, as we lost a treasured member of our research team to melanoma last year,” said Southern DHB Consultant Medical Oncologist, Dr Chris Jackson.

At Clutha Health, teams will also be ‘Going Spotty’ for the day and the café’s at Dunedin, Southland and Wakari Hospitals will be selling some ‘spotty’ themed food.

Southern DHB Plastic and Reconstructive surgeon and chair of the Melanoma Multi-Disciplinary Meeting, Mr Will McMillan said that 'Go Spotty Day is a great way to raise melanoma awareness. The annual melanoma toll in New Zealand is higher than the road toll and melanoma is the biggest cancer killer of New Zealanders aged between 25 and 45. Prevention and early detection is our best hope of improving this.  If caught early melanoma has a much higher chance of cure. '

For more information go to: http://www.melanoma.org.nz/melanoma/overview/

Deadly familial stomach and lobular breast cancers could be successfully treated at their earliest stages, or even prevented, by existing drugs that have been newly identified by University of Otago cancer genetics researchers.

The researchers, led by Professor Parry Guilford, show for the first time that the key genetic mutation underlying the devastating conditions also opens them to attack through drug therapies targeting other cellular mechanisms.

There is currently no treatment for this kind of gastric cancer other than surgical removal of the stomach as a preventive measure in those identified as carrying the mutated gene. Lobular breast cancer is hard to detect by mammography and mastectomies are also undertaken by some carriers.

The researchers’ findings appear in the US journal Molecular Cancer Therapeutics.

The team used genomic screening to search for vulnerabilities in the cancer cells that lack the tumour-suppressor protein E-cadherin. The genetic mutation that causes this protein to be lost is common in hereditary diffuse gastric and lobular breast cancers. 

E-cadherin is not a traditional drug target for these forms of cancer because the protein is present in healthy cells but absent in malignant ones. However, Professor Guilford and his team predicted that its loss might create other vulnerabilities in these cancer cells.

Professor Guilford says the research team used an approach of searching for ‘synthetically lethal’ combinations of E-cadherin loss with inactivation of other proteins, which together cause cell death.

After conducting a genome-wide functional screening of non-malignant human breast cells with, and without, E-cadherin loss, they identified a large number of such vulnerabilities that can be targeted by existing drug compounds.

PhD student and study lead author Bryony Telford says further analysis showed that the most promising avenues of attack were against G-protein coupled receptor (GPCR) signalling proteins and those involved in maintaining the cell cytoskeleton.

“We found that GPCR proteins were strikingly abundant in cells lacking E-cadherin, as were diverse types of cytoskeletal proteins,” Ms Telford says.

Next, the researchers screened selected drug classes known to interfere with these proteins, and found that the E-cadherin-lacking cells proved highly sensitive to many of the compounds while their normal counterparts did not.

Professor Guilford says that the synthetic lethal effects identified are highly promising for developing early chemoprevention treatments for people who carry the E-cadherin mutation and as a result are at high risk of gastric and lobular breast cancers.

“Making such drug treatments a reality would mean delaying or completely avoiding the trauma that high-risk individuals experience by undergoing major preventive surgery at a young age,” he says.

The study was undertaken in collaboration with researchers from Melbourne’s Peter MacCallum Cancer Centre and the University of Melbourne. The drugs were screened at the Walter and Eliza Hall Institute’s High-Throughput Chemical Screening Facility in that same city.

Professor Guilford’s work was supported by the Health Research Council of New Zealand.

In the 1990s he began leading an ongoing collaboration with a large Māori family from the Bay of Plenty that identified E-cadherin as the first known gene for inherited gastric cancer. 

This allowed family members to be tested for the gene and to decide whether to take preventative action. This research was originally published in the leading journal Nature in 1998 and the findings have now led to hundreds of lives being saved around the world.

Kimihauora Trust Manager Maybelle McLeod, who originally contacted the University and Professor Guilford to seek help in discovering the cause of the disease ravaging her family, says the findings are very exciting.

“The only choice at the moment for those of us at genetic risk is to undergo drastic surgery, and having your stomach removed is a hard thing to bite. This latest research holds out a new hope for a gentler way to save the lives of our affected whanau members,” Ms McLeod says.

For further information about this event, go to:  http://siop2015.kenes.com/

A University of Canterbury spin-out company Tiro Lifesciences is moving to transform breast cancer diagnosis and screening for all women.

The company, which has raised $600,000 capital, has developed a zero radiation breast cancer screening system with no restriction on age limits.

Each year more than 570,000 New Zealanders take part in breast screening programmes to detect cancer.  New Zealand has among the highest rates of breast cancer in the world.  Breast cancer is the most common cancer in New Zealand women, and the second most common cause of cancer death in women, with over 2700 women diagnosed with breast cancer and over 600 women dying from breast cancer each year.

The Christchurch-based company is working on commercially developing a breast cancer system by making sure it integrates into clinical workflow. Chief executive Marcus Haggers says their work has focused on reducing screening time and has made significant progress in the last six months.

Around 40 percent of women currently screened have dense breast tissue. Women with this tissue have an increased risk of breast cancer but are also the group most difficult to screen via X-ray mammography. 

“X-ray mammography is utilised for breast cancer screening in women over 45 years of age. The limitation of X-ray mammography in dense breast screening is that healthy dense tissue has virtually the same X-ray absorption characteristics as cancerous tissue, making it difficult or impossible to spot certain cancer cases on a mammogram image.

“The recognition of this problem has led to new laws being introduced in the United States, the largest medical device market in the world.

“Legally, patients must be informed of mammography’s limitations and alternative tests suggested.

Tiro Lifesciences is developing a new era of breast cancer screening. The system does not rely on absorption of X-rays (or any other radiation source) and is therefore free of the issues affecting X-ray mammography in dense breast cases. We carried out a small clinical study last year which has improved the system in preparation for a larger clinical trial later this year.”

The medical diagnostic company last year received the first repayable grant of $450,000 from Callaghan Innovation under its expanded business incubator network. The University of Canterbury is a shareholder in Tiro Lifesciences, as is Geoff Chase, a distinguished professor at the University of Canterbury, whose team of researchers has developed the technology.

It was found that, among the 899 166 women in the study cohort, socioeconomic and lifestyle factors strongly affect participation in routine bowel cancer screening, risk of being FOBt-positive and risk of having screen-detected colorectal adenoma. However, screen-detected colorectal cancer risk is not strongly related to these factors.

To read the full abstract, and for information on how to access the full text, go to: http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc201569a.html or contact your local, DHB or organisational library for assistance.

Blanks, R. G., et al. (2015). Nationwide bowel cancer screening programme in England: Cohort study of lifestyle factors affecting participation and outcomes in women. British Journal of Cancer, (5 March 2015), doi:10.1038/bjc.2015.69.

When compared with other cancer survivors, CRC survivors reported higher percentages of obesity and lack of physical activity; however, they had lower levels of current smoking. Adjusted results show that CRC survivors were significantly more likely to report lack of physical activity, fair/poor health, and other chronic health conditions compared with persons without a cancer diagnosis. Conversely, CRC survivors reported lower levels of current smoking than persons without cancer.

To read the full abstract, and for information on how to access the full text, go to: http://www.ncbi.nlm.nih.gov/pubmed/25736006 or contact your local, DHB or organisational library for assistance.

Rohan, E. A., et al. (2015). Health behaviors and quality of life among colorectal cancer survivors. Journal of the National Comprehensive Cancer Network, 13 (3), 297-302.

This Australian study explored the use of a cancer risk tool, which implements the QCancer model, in general practitioner consultations and its potential impact on clinical decision making.

The risk tool was perceived by participating GPs as being potentially useful for patients with complex histories. More experienced GPs were distrustful of the risk output, especially when it conflicted with their clinical judgement. Variable interpretation of symptoms meant that there was significant variation in risk assessment.

To access a free full-text version of the article, go to: http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc201546a.html

Chiang, P. P-C., et al. (2015). Implementing a QCancer risk tool into general practice consultations: An exploratory study using simulated consultations with Australian general practitioners. British Journal of Cancer, Advance online publication, 3 March 2015, doi: 10.1038/bjc.2015.46.

Stage at diagnosis is a key predictor of overall cancer outcome. This study analysed data from England's National Cancer Registration Service’s (NCRS) Cancer Analysis System on persons diagnosed with breast, colorectal, lung, prostate or ovarian cancers in England in 2012. One-year relative survival was calculated along with adjusted excess rate ratios, for mortality within 1 year.